UC Irvine

Background: Most US mothers initiate breastfeeding (BF), but many stop BF earlier than recommended. Mothers’ occupation and working conditions are understudied drivers of BF behaviors, and they may partly explain persistent inequities in BF by race. Further, work-related BF experiences may influence working mothers’ psychosocial wellbeing. Methods: Chapter 1 is a review of the population health and social science literature about BF. I identify gaps in this literature about how occupation and employment relate to BF among White compared to Black mothers, the role of low job control in BF, and how BF experiences relate to job satisfaction. I then propose a theoretical framework to guide this inquiry. Chapter 2 presents a study of n=970 mothers from the Panel Study of Income Dynamics (PSID). I use zero-inflated negative binomial regression models to compare BF initiation and duration for non-working mothers compared to those in professional/managerial jobs or in service/manual labor jobs. I assess whether those relationships vary for White compared to Black mothers. Chapter 3 presents a study of n=631 working mothers from the PSID, augmented by a job exposure matrix for low job control. I use path analytic models to determine whether low job control mediates the relationship between race and short-term (less than six months) as well as long-term BF (six months or more). Chapter 4 presents a longitudinal study of n=265 mothers from the Infant Feeding Practices Study II. Using logistic regression, I assess whether work-related BF problems (e.g., lack of space or time to pump, or criticism from colleagues) at three months postpartum predicted low job satisfaction at 12 months postpartum.

Results: The theoretical framework in Chapter 1 posits that structural racism influences mothers’ employment status and occupation options, which in turn influence workplace BF experiences and BF outcomes, as well as psychosocial wellbeing. Results of the following studies explicate those pathways. In Chapter 2, I show that not working predicts longer BF duration, but only in comparison to service/labor work. Also, those relationships vary by race. Among White women, non-working mothers breastfeed longest (5.9 months on average) compared to the two employed categories, while among Black mothers, those in professional/managerial work breastfeed longest (4.7 months). In Chapter 3, I show that low job control is associated with 40% lower odds of longer-term (at least six months) BF. Low job control explained about 31% of the Black-White inequity for both shorter term and longer-term BF. In Chapter 4, I show that women who report three or more work-related problems with BF have nearly 7 times the odds of developing low job satisfaction at 12 months postpartum.

Discussion: These studies demonstrate that occupation type and psychosocial working conditions predict BF outcomes and likely contribute to longstanding BF inequities by race. BF problems are work are predictive of low job satisfaction among working mothers. This underscores the need for programmatic and policy solutions, perhaps through collaboration among experts in occupational health, BF and health disparities, to better accommodate working mothers of infants in the US.